Set up Questionnaire
The following information is required to complete the set-up of your OnePersonPlus Defined Benefit Plan. Administration of your
plan is provided by Dedicated Defined Benefit Services LLC, one of the leading providers of administrative services for 1-5 person
defined benefit plans in the US. All answers are confidential. The questionnaire must be completed and signed by the employer with
the assistance of a Dedicated DB consultant and/or your financial or tax advisor. Please call 1-866-269-2706 with any questions.
Employer Information
1) Legal Name of Employer: ________________________________________________________________________
DBA Name (if applicable): ____________________________________________________________________________
Owner(s)' Name: ____________________________________________________________________________________
Owner(s)' Email Address: _____________________________________________________________________________
Mailing Address of Employer: __________________________________________________________________________
City: _____________________________ State: __________________________ Zip: ________________________
Phone: __________________________ Fax: __________________________________________________________
2) Employer ID # :____________________________________________________________________________________
3) Entity Type: C-corp S-corp Partnership Sole Proprietor LLC :
Other _________________
If an LLC, how is it taxed? Sole Proprietor Partnership C-Corp S-Corp
4) Employer's Fiscal Year End: _____________ Date of Incorporation or Date Business Began: ____________
If business entity type has changed, please explain under Notes (Item 21).
5) Principal Business Activity: __________________________________ Six Digit Business Code: _____________
6) Enter estimated Defined Benefit contribution you wish to make: $ ________________________
All contribution amounts are ESTIMATES ONLY untill we receive your final year-end data and the contribution is
approved by our actuary.
7) Do you wish to add a 401(k) plan that is administered by Dedicated DB? Yes No
This option is available only to plans that cover either (i) an owner only, or (ii) an owner and spouse.
In addition to the defined benefit plan contribution, the IRS allows elective deferrals ($15,500 plus $5,000 catch-up if
age 50) and a 6% profit sharing contribution to the 401(k) plan.
8) Financial Representative:
Name: __________________________________________________________________________________________
Company: ________________________________________________ Phone: ______________________________
Email: ______________________________________________________ Fax: ______________________________
Mailing Address: __________________________________________________________________________________
9) Accountant:
Name: __________________________________________________________________________________________
Company: ________________________________________________ Phone: ______________________________
Email: ______________________________________________________ Fax: ______________________________
Mailing Address: __________________________________________________________________________________
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Plan Information
10) Effective Date of Plan (usually the first day of the current fiscal year): _____________________________________
11) Trustee(s) (usually the owner): ____________________________________________________________________
12) Eligibility Requirements:
Union employees and nonresident aliens earning no U.S. income are not eligible to participate in the plan. Eligible
employees will enter the plan on the semi-annual date after completing the following requirements:
Age Requirement:
Age 21
Other: ______ (not greater than 21)
Service Requirement:
None (allows part-time employees to enter the plan)
1 Year of Service
2 Years of Service (requires 100% vesting)
13) Vesting Schedule for Employer Contributions:
100% Vested Immediately
6 Year Graded—0/20/40/60/80/100
3 Year Cliff—0/0/100
14) Other Plans:
Does the employer sponsor any other plans?
Yes; Description _________________________________________________________________________
If Yes, amount already contributed for 2008 to other plan: $ ____________________
No
Has the employer sponsored any plans that have been terminated?
Yes; Description _________________________________________________________________________
No
15) Related Employers:
If your business is part of a controlled group or affiliated service group, employees of all members of the group
must be covered by this plan. Please review the items below and check any that apply to you.
Yes No
Do any owners (or spouses) of the employer own interests in other businesses?
Is the employer part of a controlled group of businesses?
Is the employer part of an affiliated service group?
Does the employer have any leased employees?
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Census Information
16) Owner's Name: _________________________________________________________________________________
Date of Birth: __________________ Date of Hire: ____________________ % of Ownership: ___________________
Please list any additional owner and compensation history under Notes (Item 21).
17) Compensation (See instructions on next page)
Owner's 2008 Expected Compensation: ________________________________________________________________
Compensation History: please list the last three years of Compensation, plus any previous years if higher:
Year Compensation 1/2 Self-Employment Tax (if applicable) Plan Contributions (if applicable)
________ ________________ ______________________________________ ______________________________
________ ________________ ______________________________________ ______________________________
________ ________________ ______________________________________ ______________________________
________ ________________ ______________________________________ ______________________________
18) If you have employees, please complete the following:
Name Date of Birth Date of Hire Compensation Over 1000 Hours? Officer?
____________________________ ____________ ____________ ____________ Yes No Yes No
____________________________ ____________ ____________ ____________ Yes No Yes No
____________________________ ____________ ____________ ____________ Yes No Yes No
____________________________ ____________ ____________ ____________ Yes No Yes No
19) What is the first plan year of administration that Dedicated DB is responsible for: 2008 2009 Other
20) Is this plan covered by the Pension Benefit Guaranty Corporation (see next page)? Yes No
21) Notes/Other Information
Please sign and date below. By signing this form, you are acknowledging as the sponsoring Employer that you have received and
read the OnePersonPlus db Plan Proposal, understand the fees set forth in the proposal, and understand that a defined benefit
plan has a required annual contribution. With that understanding, you are authorizing the establishment of the plan based on the
information provided in this questionnaire. Please retain a copy of this questionnaire for your files.
Signature: _____________________________________________________ Date: __________________
Please make your check for the setup fee payable to Dedicated Defined Benefit Services LLC
Mail this signed form with your check to: Dedicated Defined Benefit Services LLC
2555 Flores St.
Suite 555
San Mateo, CA 94403
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General Information
Compensation
The following table illustrates compensation for owner(s) depending on entity type:
Type of Entity Source of Income Plan Compensation
Corporation W-2 Income W-2 Income
S-Corporation W-2 Income + Schedule K-1 (Form 1120-S) W-2 Income only
Sole Proprietorship Schedule C, line 31 Earned Income (calculate)
Partnership Schedule K-1 (Form 1065), line 14a Earned Income (calculate)
Notes
Limited Liability Company – see table above depending on how the LLC is taxed. By default, LLCs are taxed as sole proprietorships or
partnerships, but the LLC can make a special election to be taxed as a corporate entity.
Plan compensation is limited to $230,000 for plan years beginning in 2008.
Employees, other than owners, are paid W-2 income for all entity types.
Earned Income = Net Profit – 1/2 self employment tax – plan contribution.
The retirement plan deduction for a sole proprietor/partner is limited to Net Profit – 1/2 SE tax.
Other Notes About Compensation
1) When entering Compensation History do not list compensation paid from an unrelated business. For example, if your business
began in 2008 and before that you worked for ABC Inc., do not list compensation paid by ABC Inc.
2) For S-corporations, Schedule K-1 dividend distributions cannot be used as Compensation.
3) In general, Compensation does not include "passive income" such as income from investments or property.
4) Compensation must be received only from the employer (plan sponsor) establishing the plan.
5) Please refer to your CPA to determine where deductions are taken on the appropriate tax return.
Fidelity Bond
If your plan has participants other than owners and their spouses, it is required by ERISA that Plan Fiduciaries be bonded for plan
assets. A Fidelity Bond is necessary to protect the plan against loss through fraud or dishonesty on the part of the plan officials. Plan
Fiduciaries should be insured for a minimum of 10% of the plan assets, but not less than $1,000.The maximum amount required is
$500,000. A Fidelity Bond may be obtained through your business property and casualty insurance carrier.
PBGC Coverage
Defined Benefit plans are required to be covered by the Pension Benefit Guaranty Corporation (PBGC) insurance program with the
following exceptions:
• Professional Service Employer with less than 25 participants
• Owners only / with spouse
A professional service individual includes, but is not limited to, physicians, dentists, chiropractors, osteopaths, optometrists, other licensed
practitioners of the healing arts, attorneys at law, public accountants, engineers, architects, draftsmen, actuaries, psychologist, scientists,
and performing artists.
If required to be covered by the program, premiums will need to be paid to the PBGC.
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